Joyce M Sneed
Danville,VA
Summary
Accomplished and detail-oriented Claims Analyst with extensive experience in the healthcare industry, specializing in claims processing, adjudication, and system configuration. Proven expertise in working with Medicare, Medicaid, VA, and Commercial carriers. Adept at using various software platforms to enhance documentation and system integrity. Recognized for commitment to excellence and the ability to communicate effectively with senior management, associates, and customers.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Virtual Assistant
ALRI Realty and Investments
03.2024 - 07.2024
- Created virtual walkthrough
- Title search
- Send out documents to potential buyers to Docu-Sign
- Maintain Realtor calendar
- Organize First-time home buyer’s seminars
- Coordinate property management duties with vendors and contractors
- Facilitated smooth operations with proficient data entry and document management for various projects.
- Elevated client experience by providing timely customer support via phone calls, emails, and live chat platforms.
Business Analyst / Benefit Configuration Analyst
Pinnacle Tek LLC /Cognizant/Gainwell Technologies
04.2023 - 12.2023
- Validated and updated Business Requirement documents
- Reviewed state policies to establish designs for contracts and benefits
- Managed QNXT configuration for various medical coding and claims testing
- Creating claims for testing against benefits
- Identifying and triaging defects
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Enabled data-driven decision making with advanced analytics tools, generating valuable insights for organization.
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
Business Analyst
Mestasis Information Systems Inc./Elevance Health
01.2023 - 03.2023
- Created Epics and user stories using Jira
- Analyzed and validated system configurations and requirements
- Created letters to address customer service responses
- Created letters to provide benefit and claim status for member and provider inquiries
- Reviewed and validating letters to reflect customer service responses
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
Business Analyst
TEKsystems Inc./Sentara
08.2021 - 10.2022
- Created or updated Benefit Plans on Legacy system
- Updated and testing of benefit configurations for Medicaid and Medicare members, enhancing the accuracy and responsiveness of service offerings to these groups
- Ensured optimal system performance and customer satisfaction by conducting thorough testing and validation of new plan configurations
- Enhanced communication with other departments and other team members to resolve issues
- Reviewed Rx Out of Pocket, Deductible overpayments
- Submitted the overage via Change Gear
- Conducted functional testing and claims reprocessing
- Managed benefit configuration updates for Medicare and Medicaid members
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Analyzed data to identify root causes of problems and recommend corrective actions.
Business Analyst
Apex Systems Inc/Advantasure (BC/BS subsidiary)
04.2019 - 03.2020
- Created user stories and converted business requirements for Agile documentation
- Validated and tested Medicare Advantage, Medicaid, and Commercial benefit rules
- Processed claims to ensure correct results
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Boosted customer satisfaction levels by identifying areas of improvement and proposing actionable solutions.
- Provided technical support for troubleshooting analytics and reporting issues.
Sr. Denials Analyst / Revenue Cycle
Conifer Health Solutions
04.2016 - 02.2018
- Managed revenue cycle processes and disputed payment amounts with insurers
- Submitted EHRs
- Billed multiple carriers Aetna, BC/BS, VA, Cigna, and Medicaid/Medicare
- Documented and managed accounts to reduce A/R and balance accounts
- Appeals and grievances
- Disputed incorrect payments and coordination of benefits (COB)
- Gathered, organized and input information into digital database.
- Enhanced customer satisfaction rates through detailed analysis of customer feedback data and subsequent improvements in service offerings.
- Enhanced customer engagement by analyzing behavior patterns and suggesting targeted marketing strategies.
- Increased operational transparency by developing and implementing new reporting framework.
- Drove revenue growth by identifying underperforming areas and recommending solutions.
- Increased customer satisfaction by analyzing feedback and implementing necessary changes.
- Self-motivated, with a strong sense of personal responsibility.
- Excellent communication skills, both verbal and written.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Passionate about learning and committed to continual improvement.
Claim Processor/Tester
Kaiser Permanente
08.2014 - 12.2015
- Performed Unit and UAT testing for system updates
- Managed benefit configuration
- Claims processing using EPIC
- Identified and triaged defects using HP ALM
- Audit and Quality control
- Received and reviewed incoming documents and materials.
- Contributed to achievement of department goals through consistent high-quality work.
- Developed expertise in various processing systems for increased efficiency and accuracy.
- Maintained accurate records and ensured timely completion of all necessary paperwork.
- Met production targets and tight deadlines by collaborating closely with team members.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Updated quality control records and reports.
Education
BA - Psychology
Southern NH University
04.2024
Skills
- ICD-9
- ICD-10
- CPT
- HCPCS II
- DSM-IV coding
- Claims processing
- HMO
- PPO
- POS
- ASO
- Capitation
- EPO
- VA
- Medicare
- Medicaid
- Indemnity products
- QNXT
- Facets
- Epic Tapestry
- NASCO
- Power MHS
- Metavance
- MMIS
- IKA
- AMISYS
- HP/ALM
- Health Rules
- Microsoft Office Suite
- Excel
- Word
- PowerPoint
- Visio
- SharePoint
- EDI transactions
- 835/837
- 834
- 270/271
- 276/277
- HIPAA compliance
- SQL queries
- Meeting Scheduling
- File Organization
- Customer Service
- Microsoft Office
Certification
- Certified ScrumMaster (CSM)
- Certified Scrum Product Owner (CSPO)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Virtual Assistant
ALRI Realty and Investments
03.2024 - 07.2024
Business Analyst / Benefit Configuration Analyst
Pinnacle Tek LLC /Cognizant/Gainwell Technologies
04.2023 - 12.2023
Business Analyst
Mestasis Information Systems Inc./Elevance Health
01.2023 - 03.2023
Business Analyst
TEKsystems Inc./Sentara
08.2021 - 10.2022
Business Analyst
Apex Systems Inc/Advantasure (BC/BS subsidiary)
04.2019 - 03.2020
Sr. Denials Analyst / Revenue Cycle
Conifer Health Solutions
04.2016 - 02.2018
Claim Processor/Tester
Kaiser Permanente
08.2014 - 12.2015
BA - Psychology
Southern NH University